Showing 191 - 200 of 424 annotations tagged with the keyword "Professionalism"
In this sequel to his earlier seem-autobiographical novel, House of God, Shem (this time using both his pseudonym and his real name) describes the experience of a physician in the first year of a psychiatry residency in a prestigious private psychiatric hospital. In this first hand account it is assumed that the author is the resident, Dr. Roy Basch; he describes not only his experiences with a variety of patients but also with the other doctors and the staff members of the institution. It is not a happy place and in the telling of the story there is a biting irony and a sense of the absurd.
It is obvious from the first that Dr. Basch is very serious about becoming a psychiatrist but that he is also searching for meaning and connections. He finds that colleagues may often hurt you more than your patients. Another issue addressed is that of competing psychiatric theories, particularly the competition between pharmacologic treatment and psychoanalysis. Issues about drug treatment trials and the questionable way in which they are conducted also receive attention, as does the problem of insurance coverage for hospitalization.
The fact that psychiatrists often specialize in their own defects becomes a reality to Dr. Basch. There are not many exemplary people in this book--hopefully it exaggerates the real situation. There is, surprisingly, a sort of poignant positive ending.
This is a story about Bea, a single woman professor who has just had a caeserian section for an 11 pound boy, and her hospital roommate, Corinne. Bea describes her own discomfort with Corinne’s race, while admiring Corinne’s pride and nurturance toward her newborn son. As the story progresses, Corinne is betrayed by the medical world in a multitude of ways: misdiagnosis, racist treatment, denial of medical treatment, and incompetent care, resulting in Corinne’s sepsis and her son’s eventual death.
At the end of the story, after Corinne and Bea are discharged from the hospital, Bea tries to visit Corinne and deliver the pictures of her child that Corinne hadn’t been able to afford. But at the last minute, Bea turns away. Although she wants to help, she feels wholly inadequate, and believes she will only cause Corinne pain. Ironically, Bea remembers her last night in the hospital, how she covered her ears as Corinne’s baby whimpered, and as her own breasts surged with milk for the crying child. Even though her instincts and body tell her what to do for Corinne, she is not able to listen.
In March, 1981, in Vermont, Charlotte Bedford goes into labor. She has decided to give birth at home with the help of a midwife, Sybil Danforth, but complications develop. Charlotte has a seizure, her heart stops, and she does not respond to CPR. The fetus is still alive, so Sybil delivers him successfully by Cesarean section, with a kitchen knife. But the bleeding when Sybil makes the incision convinces her assistant that the patient’s heart was still beating. She reports this to the police and Sybil is put on trial for involuntary manslaughter.
The story of the trial is told by Sybil’s daughter, Connie, fourteen years old at the time and now an obstetrician-gynecologist. The acquittal comes at a price: the midwife finds herself no longer capable of delivering babies, and both she and her daughter are given a new insight into the uncertainty which underlies so many of medical decisions. At the end of the novel we are left uncertain whether or not Charlotte was still alive when her baby was delivered.
Miss Armistead is a nurse in the surgical division of a hospital. She is being courted by two men, Dr. Joe Trask, the chief resident, and Dr. Mort Baker, an established and very successful surgeon. Everyone in the division is taking bets on her choice. Most assume she will choose Baker, the wealthier, more powerful doctor.
Then Miss Armistead develops appendicitis and requires emergency surgery. Joe Trask is on duty and has to begin the operation before Baker arrives, but experiences a terrible crisis of confidence, becoming helpless with fear. Baker arrives and completes the operation.
Everyone assumes that this will clinch Baker’s victory, but when Joe tells her how he was unable to operate on her, Miss Armistead takes this inability to see her as just another patient to be proof of the depth of his love for her, and agrees to marry him.
The nurse in this O. Henry Prize-winning story is Mary McDonald. She’s been a nurse for over 40 years and understands fully that the new pain she feels is a signal of her cancer’s spread, and for her, the beginning of the end. The remainder of this story is a retrospective of her life as a nurse and most significantly her role in forming a union, thirty years previously, at the local hospital.
Deftly placed between her reminiscences are scenes of her children’s visits to their dying mother, and perhaps as a final legacy to her nursing colleagues, Mary’s attempt to convince Eunice, her caretaker at the nursing home, to unionize the facility.
The New Medicine and the Old Ethics, in Albert Jonsen’s own words, is a "secular aggadah." Jonsen explains that one Talmud reviewer defined aggadah as "a magical rabbinic mode of thought in which myth, theology, poetry and superstition robustly mingle" (4). The book begins with a personal essay entitled "Watching the Doctor." Jonsen establishes his premise that the moral history of Western medicine is best understood as a paradox between altruism and self-interest, a paradox alive and well entering the 21st Century.
He then takes the reader on his "secular aggadah," blending history, myths, and stories that trace important moral developments in the practice of Western medicine. In "Askelepios as Intensivist," we learn of the early Greek values of competence in shaping medical practice. Through the influence of the Church in the medieval period, Western medicine incorporates the value of compassion through the Biblical Good Samaritan, struggles with problems of justice in the care of the poor, and further elaborates the meaning of benefit.
In "The Nobility of Medicine," Jonsen describes the contribution of Sir William Osler and other knighted medical men of the 19th Century who established the ethics of noblesse oblige in the medical profession. He traces this noble tradition to the medieval Knights Hopitallers of Saint John of Jerusalem, a group of religious who provided hostels for pilgrims to the Holy Land and cared for the sick. With essays on John Locke and Jeremy Bentham, Jonsen brings us to the 20th Century and the play of individual rights and utilitarian values in the moral life of Western medicine.
In the final essays, Jonsen describes the mingling of these traditions as a means to establish a moral frame for Western medicine in our current times where technology and science have achieved and threatened so much. Ethics, he argues, "is disciplined reflection on ambiguity" (130). In the last essay, "Humanities Are the Hormones," Jonsen brings his "secular aggadah" full circle.
He argues that the paradox of altruism and self-interest that runs through the moral history of Western medicine must continually be vitalized and examined through the Humanities. The Humanities are "the chemical messengers that course through the complicated institution of medicine and enable it to respond to the constantly changing scientific, technological, social, and economic environment" (147).
An extraordinary phenomenon began to emerge a century or so ago, which, as it proceeded, allowed us a glimpse into what a society would look like when most of its members, rather than a select few, lived to, or more precisely, near, the limit of the human lifespan. Now we are facing the possibility of extending the upper limit of the human lifespan. How we live within this new world will be the result of numerous individual as well as corporate (in its fullest sense--business, professional societies, religious organizations, political bodies) decisions.
Stephen Hall, through compelling and clear writing takes us behind the scenes and into the lives and labs of the researchers and entrepreneurs who are seeking to slow down, stop, or reverse the aging process--those who intend to bring about, if not actual, then practical immortality. Figuring prominently throughout the book are Leonard Hayflick, early pioneering researcher on aging cells, and the charismatic (and former creationist) researcher-entrepreneur, Michael West. Rounding out the narrative are commentaries by noted ethicists and the chronicling of the political responses to these scientific and business developments, especially in regard to stem cell research.
Summary:This is a selection from "The Call of Stories" in which Robert Coles argues for a medical ethics rooted in particular lives and particular situations, rather than (or to supplement) the ethics of abstract rules and principles. He tells the tale of an "uppidy nigger" in Clarksdale, Mississippi, in 1967 who took issue with her clinic doctor because he was insulting and condescending toward his patients: "I told him I expected more of him. Isn’t he a doctor? If he can lord it over people, being a doctor, then he ought to remember how our Lord, Jesus Christ behaved . . . did He go around showing how big and important He was . . . ?"
This volume nicely supplements the few other anthologies of literature on medical themes currently available in that it covers a wider historical span. Selections from the Bible, Giovanni Boccaccio, William Shakespeare, Rabelais, as well as 18th-century writers including Pepys, Daniel Defoe, Malthus, Schiller, and Goldsmith provide an array of historical touchstones that offer windows onto medical and literary history and points of comparison for the larger selection of works from the 19th and 20th centuries.
The selections are mostly short--averaging around 10-12 pages. Each is introduced with lively, often witty, comments by Gordon, whose popular Doctor in the House series was adapted for stage and screen in England, and whose associations with the medical world include an editorial position on the British Medical Journal as well as a wife and two children who are physicians. Many of the selections focus on the figure of the physician viewed variously from the viewpoints of patients, other physicians, and him or herself.
Selections from novels by three Victorian women doctors as well as selections from several physicians’ diaries provide unusual additions to a useful collection of excerpts from well-known literature including works by Scott, John Keats, Jane Austen,George (Marian Evans) Eliot, George Bernard Shaw, Hardy, Aldous Huxley, Sir Arthur Conan Doyle, Sinclair Lewis, F. (Francis) Scott Fitzgerald, Waugh, Orwell, and more recent and popular fiction, up through Erich Segal.
Mrs. Tucker, Her Daughter Emily and Dr. Duff features Raymond Duff, M.D. as the storyteller. Dr. Duff was a pioneer in neonatology and produced many scholarly works in that field. One of his areas of research was grief and bereavement. However, his interests and this story go well beyond "grief resolution" to an exploration of the boundaries of the clinician-patient relationship.
The pseudonymous Tucker family and Dr. Duff share together a number of deaths and their aftermaths over a short period of time. In recounting the lessons learned from and privilege of being a part of the Tucker family "drama," Ray Duff reminds viewers "that although there inevitably is loss in what they encounter through their work in the health professions, there also is hope."